Healthcare Fraud

Conservative estimates suggest that healthcare fraud costs $68 billion annually, which is about three percent of total healthcare expenditures. Some experts believe the costs of healthcare fraud may be as high as $230 billion. Whistleblowers play an important part in reducing fraud and the related expenses. Protection of whistleblowers is vital to encouraging people with knowledge of unlawful activity to step forward.

Schneider Wallace Cottrell Konecky Wotkyns LLP was established almost a quarter-century ago and has grown into a top national litigation law firm. We often take on complex issues surrounding fraud and whistleblowing in the medical industry. Our lawyers remain current on the latest healthcare scams and take a modern approach to resolving legal issues surrounding the fraud.

Common Healthcare Scams

Many healthcare schemes target Medicaid and Medicare government programs. Fraud targeting private insurance groups is also common. Whistleblowers are in a position to learn about and report the fraud, including:

Kickbacks occur when a medical provider accepts, offers, solicits or pays remuneration in exchange for inducing, referring, or otherwise generating business or sales. For instance, a doctor is not permitted to accept a portion of Medicare payment for referring a patient to an imaging center for x-rays.

Upcoding involves billing for services or goods at a higher level than the actual service or product provided. For example, a doctor might bill for a complex surgery procedure upon having performed a much simpler outpatient procedure.

Billing for unnecessary services or products is also unlawful. Doctors are entitled to differences in medical opinion. In this case, a doctor may argue that the item was medically necessary and the issue of a doctor’s ability to make autonomous medical decisions that benefit the patient might come into play. An expert might shed light on the reasons a procedure or product was appropriate or inappropriate under a given circumstance.

Billing for services of products not provided is illegal. In these cases, the medical professional might bill Medicaid for procedures the doctor did not perform or medical aids or medication not actually furnished to the patient.

Unbundling describes billing for individual items that are generally billed as one item. For example, a laboratory usually charges a set price to test a series of vitamin deficiencies, such as iron, folic acid and D, in one blood panel. If instead, the doctor or lab charges for each individual test, the cost generally increases considerably.

Charging for an unseen patient includes charging for doctors’ appointments for patients who do not exist or were not seen by the doctor.

Medical identify theft is generally perpetrated by a patient to obtain medical care under an assumed name. The patient might steal another patient’s identity or the doctor’s identity, an act that is often related to the illegal sale and distribution of prescription narcotics.

Learn More About Medical Fraud Issues that Can Give Rise to Litigation

Learn more about health care fraud litigation and the rights of whistleblowers and medical providers at an appointment with Schneider Wallace. We have offices in Houston, San Francisco or Scottsdale and litigate in jurisdictions throughout the country in state and federal administrative agencies and courts.